| NPI | 1174752257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: AZ 006827) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS015998) |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2015-12-30 |